Appendicitis is an inflammation of the appendix, the small, tube-like structure attached to the colon in the lower right portion of the abdomen. Symptoms of appendicitis include abdominal pain and tenderness that usually begins as vague discomfort around the navel, then moves to the lower right and worsens over the next few hours. The abdomen may become rigid and very sensitive to pressure.
It is true that in many cases antibiotic therapy may be an effective alternative to surgery for this condition. A five-year study from Finland, published in September 2018, found that most people treated with antibiotics didn’t need follow-up surgery. However, not everyone who develops appendicitis can qualify for antibiotic treatment, which works only in uncomplicated cases, in which the appendix hasn’t ruptured. If it has, immediate surgery is needed. A CT scan can often show whether an appendix has burst or is about to. This occurs in about 20 to 30 percent of all cases.
If antibiotics are an option, you don’t get a supply of pills to take home. In the Finnish study, the treatment involved three days of intravenous antibiotics given in the hospital. Then patients could go home and take oral medication for another week. Study leader Paulina Salminen, M.D., Ph.D., of Finland’s Turku University Hospital reported that there are “no severe complications associated with the antibiotic therapy, so it’s a safe option.”
Being hospitalized for antibiotic therapy may make this choice less attractive, since laparoscopic surgery for appendicitis often can be done on an outpatient basis. In this procedure, the surgeon views the inside of the abdomen with a miniature television camera attached to a long metal tube. The tube and surgical instruments are inserted through small incisions in the abdomen. Laparoscopic appendectomy has largely replaced open-abdominal appendectomy, an inpatient operation with a longer recovery time.
The Finnish study found that 61 percent of the 257 patients treated with antibiotics did not need surgery during the five-year follow-up. But 100 others eventually did need an operation, most of them within the first year after antibiotic treatment. None had any adverse outcomes.
To find out what treatment prospective patients would choose for uncomplicated appendicitis, researchers from the University of North Dakota conducted an online survey of 1,728 people. Results, published in May 2018, showed that most said they would prefer laparoscopic appendectomy over surgery with an open incision or antibiotic treatment. The researchers noted, however, that a “meaningful number” opted for antibiotic treatment, suggesting that this approach would be more attractive if the failure rate wasn’t so high.
Andrew Weil, M.D.
Paulina Salminen et al, “Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial, JAMA September 25, 2018, doi:10.1001/jama.2018.13201